Clinical Cases

The Psychic Apparatus

Dr. Mahesh Ghandi discusses the interaction of ego, Id and superego and presents a case to illustrate.

Sigmund Freud’s philosophy is reasonably complicated and he postulates that psychosexual development establishes the foundations for the growth and development of our personalities. Through this theory, he also understood that the ways we interact with the world depends on the various habits we develop during these stages. Each individual in this world falls into one of the three levels of Ego.

Stage one… is the Level of Id – The Level of The Pleasure Principle. We are born with our Id and it is a vital part of us as individuals. Here, the basic needs of life and survival are fulfilled. The Id seeks immediate gratification regardless of instinct, homeopathically; the Id is instinctual, sexual and has aggressive drives. This is the inner song that we have from birth. This is the source. The Id comes in the form of dreams and delusions, plus a survival sensation, with sex and aggression.

Stage Twois the Level of Ego – The Level of The Reality Principle. Here, individuals start to develop the second stage of their personalities. The ego is where the human and social part comes into play. Individuals understand that other people have needs and desires and that sometimes being impulsive or selfish can hurt us in the long run. Basically, here individuals learn they have to control themselves in accordance with the situation.

Stage Three… is the Level of Superego – The level of The Moral Principle. The Superego is the moral part of individuals and establishes itself because of ethical and moral restrictions.

If the Id is overpowering, the aggression and sexual impulses and self-gratification take over the person’s life.  If the superego becomes too strong, the person would be driven by rigid morals, would be judgmental and unbending in his or her interactions with the world. Freud understood that the ego was the strongest level so that it can satisfy the needs of the id, and not disrupt the superego, and still take into consideration the reality of every situation.

 

Case Example

(Note: D: Doctor, P: Patient, Italics: Consultants commentary, Bold: Pertinent portions in the case, HG: Hand Gestures)

This is a case of a man in his late 20’s diagnosed with Obsessive Compulsive Disorder (OCD).

D: Tell me what the problem is?

P: Currently my problem is watching excessive porn and drinking alcohol. This goes together. Alcohol and porn. When I am not watching porn, I don’t drink alcohol. I was very low in confidence, in my childhood days I was very shy.

I decided to become an actor. I feel I can control this, it is the power of the subconscious mind, and you can do anything. I started using the tricks/techniques in those self-help books and in the beginning it was helping me and gave me confidence that everything was going to be alright. It helped me in the beginning, and I was completely into acting and I was doing well. But then again I couldn’t complete my studies; when I went to the examination hall, I used to withdraw.

There was a girl that I went to school with. For me, it was love at first sight, but nothing from her side. Then I read The Secret and knew I had to visualize to get what you want. That girl was not in love with me but somehow I felt if I used these techniques in the book I would get her. So I started doing those techniques obsessively and withdrew from everyone.

Then I met this other girl, at age 25, my first relationship. I wasn’t attracted to her, and inner guilt started, and built up more and more. Whenever she used to go out to meet her family I started drinking and watching porn. Then this porn thing goes on for 5-6 hours. It affects my life, it is an urge. Sometimes I vomit and drink more during these sessions. It has been going on since 1.5-2 years.

There is one more thing I want to share with you. I have been in three relationships. Out of 3 relationships, 2 were with guy friends. One of the men was the love at first sights girl’s father. He was very nice to me and cared for me a lot. I had him only as a friend and he loved me so much, I thought he cared for me so I never objected. He did whatever I wanted to do, it was love from his side and not my side.

Then came U, my first girlfriend. We never had penetrative sex. Never was I sexually attracted to her.

After this, I had a relationship with a friend who was my age. For the first time, I really loved him. I liked to cuddle him. When I was with him I didn’t feel like drinking or watching porn. Whenever he leaves for 4-5 days somewhere I again pick up this habit. I am not attracted to other men, even I see gay porn and it disgusts me. But I don’t know what makes me want to cuddle men. I never had anal sex, anything of that sort just physical and kissing.

That’s it. This is the problem.

Before it was excessive spirituality but that was replaced by alcohol. I drink alcohol for 7-20 days, and then I start praying. It is an obsession, I pray, pray, pray, and then I see visions and god in dreams, but then I got back to alcohol.

When that friend is there I don’t feel like drinking or watching porn and I feel little normal.

D: So what is your problem? What is really bothering you?

P: Frustration. I never had a good sex life. The first girl I was in love with, she took 2-3 years of my life. I was like a recluse. Maybe I feel I am too sexually frustrated that is why I am watching porn. It could be one of the reasons.

D: How does it bother you? Many who watch porn are happy – why do you excessively pray after?

P: I feel lots of guilt about it.

D: What is the guilt?

P: It’s a virtual reality.

D: Talk about guilt a little more.

P: Why I drink with porn is because it gives me a 3D effect. Most of the time I haven’t ejaculated yet, I watch porn, and drink and pass out. It is sexual frustrations. When my friend is around, I feel like god has sent someone to look after me and then I am very normal. I started drinking alcohol 2 years back. I am not a social drinker, I don’t like to drink with friends, and I don’t like taste of alcohol. When it comes to porn I drink it and drink it, and vomit and drink more.

D: I am not asking why, but how does it bother you?

P: It affects my life. I get into deep depression because of that.

D: What is the depression about?

P: I get into this spirituality a lot. I think it is because of my dreams.

D: What dreams?

P: I wanted to become an actor, but this girl became my only dream. I wanted to be with only her. But after another came, then I forgot about the first girl. When I got into these books like Power of Subconscious Mind and The Secret, I began excessive meditation. I see visions, I see numbers, 111, 333, page 111, someone calls me and the call is 1:11. I have visions of god and out of body experiences. Maybe some devil has gotten into me. Before I got happy with the visions, but now I feel sickness of mind.

I feel helpless nowadays because I feel confidence is my problem. Before it was God. I know there is a God. But if my friend is not there I feel there is nothing in life. I cannot act normal without him. I try to pass time in meditation. God, he helps me until the time I am with him. But when it comes to the real world, in an uncontrolled environment I feel urge to drink and have porn. I really enjoyed Vipasana meditations. I have this deep fear in me.

D: What is the fear?

P: Once my friend leaves, what will happen with me? Because I don’t think I am capable of leaving this habit of drinking and watching porn.

D: So what is the problem?

P: God is there, I don’t deny the existence of God. This friend of mine I think God sent to me.

D: Why don’t you want to drink and see porn?

P: Before I used to watch porn and then masturbate and that was it. But now it is habit, the two together.

D: How does it bother you?

P: I vomit. I watch porn for days and days, for 1-2 months. (Gesture – Patient makes a disgusted face and scrunches up his nose.)

D: So how does it bother you?

P: It affects my health. I don’t socialize. Before there was not much social life. I was a recluse. I don’t do anything creative. I am not working on my goals.

D: Why didn’t you tell this girl?

P: She knew I wasn’t attracted. We are not in this relationship anymore.

D: What does this friend mean to you?

P: He is my Krishna (Hindu God). Sometimes I feel God has sent him.

D: What does he mean to you? What does Krishna mean to you? In what way, what is he for you?

P: I feel he is my soul mate. But even he is a very straight guy and he has a normal life. He has had 7-8 girlfriends. He led a very sexually active life. We have to imagine women to ejaculate. We kiss each other and cuddle each other. Why this is happening to us? We have no physical attraction, but why so much love? I feel very normal when I am with him. I’ve known him for 1-2 years. I was talking to him on phone. He gave me mental support always. He is my only link to the world.

D: In what way?

P: I never tried to maintain that with my friends. Even if they want to reach me, they reach me through him.

D: He is your link to the world?

P: I avoid people generally.

D: Why?

P: I feel they won’t like me. This friend of mine is quite popular in our friend circle. I feel that other friends feel that he is wasting his time with me. Such a waste like me. So that is why I avoid them. But he tells me none of them think like that.

D: Tell more about not confident, they won’t like me, I am a waste?

P: Waste means, it’s not like I have done achievements. My work was appreciated by the mentors.

D: I am not getting you, why is this obsession of seeing porn?

P: Alcohol is the problem.

D: Why do you need alcohol with porn?

P: I explained that it gives me 3D effect. I feel as if the woman is there. I feel woman is coming out of the screen. That’s why.

D: Describe your nature to me. I want to know you as a person. Tell everything you can about yourself.

P: My childhood I was a very shy kid. Again never attracted. I struggled speaking English. My dad was an army officer and everyone was good in conversation, I and my sister were not. It was like a social stigma. Students would bully me and would be making fun of me, calling me dumb. I experienced all that and my dad never took care of us in our growing years. And my mother, she doesn’t know, she is a very loving woman but didn’t know how to look after us.

D: One is shy, what else?

P: There is lots of guilt in me. (Gesture – Patient makes a disgusted face and scrunches up his nose.)

D: Tell about this guilt.

P: I always feel I am not doing enough. I always feel if someone says something to me, I feel that person is not responsible for it. There is something really wrong with me, that is why he is feeling that.

D: More, what is the guilt? You aren’t doing enough…what is the guilt?

P: I am not doing enough, only watching porn.

D: What is the guilt about it?

P: It is that virtual reality again; I feel I am fooling myself. What a failure I am, watching porn at this age.

D: Little more, guilt is different, failure is different.

P: Guilt is what I feel more and more. I am depressed and feel I feel I am wasting my time.

D: Yeah but what is the guilt?

P: Watching porn at this age.

D: What do you feel because of watching porn and drinking?

P: Sense of failure.

D: And what is the guilt?

P: Guilt is not caring for my family. They don’t know anything that I do. Most of them they don’t know anything. (Gesture – Patient makes a disgusted face and scrunches up his nose.)

D: Are your parents in Mumbai?

P: No they are not. They don’t know. I feel I am cheating them. I feel I am cheating people who love and care for me. I feel I am cheating myself. I still suffer from inferiority complex, I am disgusting.

D: Tell me about this. What is inferiority complex? What is the meaning of this?

P: I feel inferior to others. I feel they are more talented. They are more resourceful.

D: So what is inferiority, what is inferiority?

P: I feel I am not good enough, that’s what I feel. I don’t feel jealousy, sometimes I feel but not much. These people are really talented and good enough.

D: How do you feel?

P: I feel I am not very sociable.

D: How do you feel in a group?

P: I feel very awkward. People are not feeling that way, but I feel awkward.

D: What is the feeling inside? Go a little deeper.

P: I don’t like the crowd. I feel discomfort. I have a fear that they will end up knowing I am a fool. They make fun of me.

D: What is a fool?

P: That I don’t know much. I have not read many books. I cannot make interesting conversations. They feel like I don’t belong to them. I cannot be part of the circle.

D: So how does it feel not to belong there? What is the experience of not being a part of it, not belonging?

P: It bothers me. But It never used to bother me much. Before there was a God, I was obsessively praying.

D: Why did you obsessively pray?

P: I had really weird experiences. After the alcohol and porn. Before there was a group of friends, but I always withdrew from them. If I went I would end up gossiping and do things I don’t want to. If I gossip I feel strong guilt about it. When I do gossiping I do enjoy it.

D: Then why you don’t like it?

P: I feel guilty about it. Talking about people like this. Because when they talk about me I feel bad. I should not do that. I should feel guilty about it.

Then I read spiritual and self help books.

D: Why were you reading this?

P: They promise all of these things. Visualize. Ask and it’s given.

D: What are the things that you read in the book which helped you in your personality?

P: I have to be okay with attachment. It is what you lack. I knew how to speak with people but I guess it brought more damage than good. I did things I never thought I would do. I am a film maker and got appreciation for that, I have even made a short film and got appreciation for that.

D: What are your interest/hobbies, things that you really like?

P: Photography. Films. Reading books. I don’t like watching films in theaters. I read them as a text book. It is not for entertainment. I like movies about underdogs.

D: What you mean by underdog?

P: Those people who are looked down upon in the beginning, but in the end they emerge. Like the movie, Pursuit of Happiness. I like films where the guy is an underdog, the man who is in love and the woman doesn’t love him, later on he convinces her that he deserves her love. I like movies about how he is just an ordinary man, doesn’t have extraordinary qualities. But I stopped watching these films since I started watching porn and drinking alcohol. I felt they were foolish.

D: Any particular porn you like that makes you feel better?

P: Mostly I watch there are only women. I like hardcore and gang bang porn. The worst I have gone to is watching images of 15 year olds if I don’t get aroused. Then I get into extreme guilt most of the time. (Gesture – Patient makes a disgusted face and scrunches up his nose.)

D: How do you feel when you watch these 12-15 year old girls?

P: I feel disgusting. (Gesture – Patient makes a disgusted face and scrunches up his nose.)

D: What do you mean by disgusting, what are you doing with your nose?

P: It is almost like rape. I feel what kind of man I am?

D: What kind of man are you? At that time, what do you feel?

P: I feel very sad.

D: What is the feeling you get about yourself, watching disgusting, rape etc.? What does it makes you feel?

P: I always feel there is a devil in me.

D: What do you mean by devil?

P: Something I feel.

D: What does this devil want?

P: He wants me to be depressed and low.

D: These are the judgments, but what does the devil want? Tell me about the devil in you, what does he want?

P: Watching these kinds of disgusting things. But after excessive drinking I have explored the layers of my personality too. I never knew images of young girls and adolescent girls would attract me. But when I started drinking I would watch these images. The saddest things I have done, I saw scat porn.

D: What is scat porn?

P: When women are defecating. When I watch that I feel disgusting after ejaculating. I am drooping to extreme levels of perversion. Then there was a sudden realization of how bad I am. I felt maybe I am pervert and don’t feel good.

D: Why you don’t like being a pervert. How are perverts?

P: They are bad. They exploit. They are disgusting, bad people. The way a pervert looks. They look always lustful. I don’t like the face which asks for sex all the time. (Gesture – Patient makes a disgusted face and scrunches up his nose.) My ideal image is like a saintly face.

D: What is the difference between a lusty man and a saint?

P: Saintly face, detachment for the world, care for the world, love for oneself and others.

D: How are lusty people?

P: They want sex. They can go to any extreme. They can harm anyone. They can rape their mothers. They can rape their sisters

D: Why is it not good?

P: I cannot imagine myself doing it. I would feel like killing myself.

D: That is a reaction. Because? Why would you feel like killing yourself? What does being a pervert mean?

P: Extreme deformity of senses, perception. Like when you see vomit or someone puking. The kind of disgust you get.

D: What dreams you get?

P: One dream came that I came to you and confessed I am gay. I don’t find anything wrong with being gay. Gay people are not perverts for me. I believe there should be no promiscuity in relationship. I see God also in my dreams.

D: Any other dreams? Pleasant or unpleasant?

P: The unpleasant dreams I get is incestuous dreams. It was a wet dream about my sister. I thought how can my sister come in this dream?

D: Any other dreams?

P: I am seeing this pot full of shit (fecal matter), and it is overflowing.

D: Any creatures you see?

P: Snakes I have seen crawling on me.

D: Do you get scared?

P: Yes in these dreams I feel scared. Once I had a strange dream I had watched porn and alcohol, I got guilt, I started chanting and then I slept. Then there was a beautiful woman, so I went and tried to grab her, when she revealed her face, she had fangs and was very ugly.

D: Fangs like what?

P: She was very ugly. She wanted to devour me. But I ran away. She looks very scary and I got scared. It was horrible. There was woman, who was very beautiful but she was devil, there was some creature and it tried to devour me and then it vanished.

D: What are your fears?

P: My fears are being alone in a room. I feel if I am alone, I will end up watching porn and drink alcohol. Before that I was never scared. In childhood I was a little scared of ghosts.

D: Generally, how do you react to animals?

P: Compassionately. I like pets and I always wanted a dog or a cow.

D: Are you very organized?

P: No I am not, though I want to be.

D: What do you like very much in food?

P: Nowadays I like anything, and I only eat to survive that is it.

D: Do you have salivation in sleep?

P: Yes.

End of the case.

 

Case analysis:

In this case there are a few prominent and recurring themes such as:

  • Saint vs. sinner
  • Alcoholism and Pornography
  • Sexuality and Guilt (Guilt about sex)
  • Love and care
  • Low self-esteem
  • Others are better than me
  • Self help books that will help him function in life
  • Uncontrolled world
  • Face gesture of disgusted (Gesture – Patient makes a disgusted face and scrunches up his nose)
  • Recluse – “They won’t like me, I am like a failure, and my friend is popular. They will put me down, make fun of me. I am awkward in a group; they know I am a fool. I don’t belong; I am not part of the elite.”
  • Cheating – “I am cheating people who love me.”
  • Inferiority Complex – “Others are more talented, I am not good enough, I am not so jealous.”

The way this person speaks about his male companion who helps him feel better, increase his self-esteem, gives him love, care and nurturing, resembles a dog who wants the master to guide him. He is also experiencing disgust about himself and has an inferiority complex when he compares himself to others.

The whole case is about a conflict within himself  (me versus myself). We see this in domesticated animals, where they have to become civilized, and if they are sexual and aggressive, then they do not belong to society. For these domesticated animals to be loved and feel like they belong to society, they have to control their urges for sex and aggressive side. They have to hide the animal part within.

The other interesting and prominent part about this case is the patient’s self-disgust. He feels dirty and his delusions support this disgust feeling. He has dreams of incest and having sex with his sister. This makes him feel like a devil inside, where the opposite is the saint. We can take this as the two sides of the animal kingdom.

This is a perfect example of the animal versus the Super Ego. He is constantly fighting with himself. This can be taken as antagonism with oneself or self reproaching. The patient basically is saying that for his survival, he cannot be alone, for if he is alone, then the Id comes out (instinctual, aggressive sexuality with no understanding of the consequences).

We have to see what needs to be treated in this patient. In this patient, he feels low and has a great conflict over sexuality. He feels lots of guilt. He likes movies about under dogs – people who are looked down upon and then who make it in life. There are elements of incest, snakes, women turning in to animals and dreams about devils.

Here we see themes of the Domesticated animals. There is a clear conflict between Super Ego and Id.  The patient is battling between his Super Ego and norms of society, versus his instinctual parts of the Id. The fight is within himself, it is me vs. myself.

Animal themes:

  • Main thing is the struggle between the situation or the self (me versus myself, or me versus the other)
  • Comparison
  • Competition (am I better, or is he better)
  • High vs. low
  • Strong vs. weak
  • Predator vs. prey
  • Dominating vs. dominated
  • Persecutor vs. persecuted
  • There is also a split: Devil vs. Angel, I vs. myself, I am disgusted with myself, I hate myself
  • Contradiction of will: One part wants something and the other wants another
  • Jealousy
  • Malicious
  • Attraction and sexuality

Main themes of Mammals:

  • Hierarchy: Within the mammalian groups there is hierarchy and they have the ability to form complex societies – “I am better than you, you are lesser than me.”, who is up and who is down.
  • Group: Mammals often travel in a group, herd, pride or pack, it is important to feel I belong to the group or the herd – to do this, one must sacrifice something; there is a compulsive need to belong to a group; fear of being expelled from the group.
  • Friends: Intense need and dependence on friends.
  • Connection to family: Strong connection with immediate family is very important.
  • Safety and Security: Mammals feel safe and secure in the group.
  • Comparison (elite vs. lesser).
  • Looked Down Upon: Feeling of being looked down upon.
  • Dominance vs. Subservient and Submissive: The fight for dominance is very important in mammalian groups. There is a low versus high hierarchy.
  • Mother: Need to be mothered or mothering.
  • Love, Care and Nurturing: Need for care, love and nourishment; Issues of separation from mother. Needing motherly care, warmth, nurtured, anxious about children; all mammals have mammary glands which produce nourishment for the young.
  • Menstrual and Lactation Problems: Problems with menses and lactation in females (aggravated before/during menses, heaviness in menses, lactation can be too long or not enough).
  • Domesticated animals have a strong conflict regarding sexuality, they are self critical, and have much self contempt for themselves; disgust for self, looking down upon oneself, dirty feeling.
  • Abuse.
  • Fear of snakes.

Remedy: Lac caninum, 1M

Follow-up after 1 month: 

D: What are the changes?

P: After these 30 days, there have been lots of positive changes in me. There is a real shift. I am feeling more positive. I am doing things which I am not able to do before. My concentration has increased. I sleep less and work more.

D: Before you were sleeping 12 hours, are you still?

P: Now it is come down to 6-8 hours and I am working more. Those sexual thoughts are not bothering me much. Before I used to think about sexual things and feel guilty. I feel that my mind space has increased and I have more space to think about productive things, the things I really want to do. I have noticed that my concentration has really increased. Now I can work 4-6 hours productively. I am completely into my work and I enjoy my work now.

D: And the feelings you had towards yourself?

P: My self esteem has improved by 60%. 60% I feel I have healed. The intensity is not that strong when it comes out. I feel it is within my control. Before they used to get out of control.  Before I used to see pornography a lot and now for the last 20 days I didn’t have the urge to see. There was no urge. It is quite strange but I didn’t feel like masturbating too. I didn’t feel like watching or drinking!

D: You didn’t drink?

P: Not at all.

D: What about your relationship with the boy?

P: He is still there. He is still around. Even he sees changes in me. But there is no guilt about him that he is around. We share the same intimacy and love. We don’t fight much. He is happy to see me like this, working towards my goal and good things of life. My social interaction has improved, before I used to cut down from social life, but now I revived it. I feel comfortable with people now I feel I can socially interact. I don’t feel bored. I can communicate with them. I don’t feel out of place now. I get to see nice dreams. Before dreams used to trouble me a lot and they used to be not so pleasant dreams.

D: What about the tired feeling?

P: I don’t feel tired. I had a whole day outing with friends and came back at 9:30-10pm. Before I would be so tired and go and sleep. But I felt like doing my work now. I feel that now there is direction in my life. The confidence level is going to improve because of my concentration. It shows in my work.  I hope this is not temporary. I am really enjoying it. It is blissful. I want to live like this forever.

Follow up after a year:

D: After how long are you coming to me?

P: It has been more than a year now.

D: How are you generally?

P: I am quite good.

D: In what way? How is it compared to before?

P: It was like hell when I came earlier, then I started your homoeopathy and it was quite good after that. As I started taking your pills I gradually started having control over my mind and body language. I could restrict myself to things and I could sleep without thinking. My thinking process was very fast earlier and now it has gradually come down. Now only when I need to think, I think.

D: How are your obsessions?

P: They are very much in control. I used to have obsessions about girls but it is quite in control now. I remember all those things but I am not bothered by them anymore.

D: So do you think homoeopathy has helped you?

P: Yes it has. In my 8th, 9th and 10th class I know how royally screwed I was. I used to cry for the whole day and night. I would get scared talking to my parents but luckily I got you in 9th grade itself but my dad took me to some religious places because he thought I had some other problems and that there were spirits in me. Luckily when I grew older, I realized that it was not about that. I came to you that time without informing my parents and started homoeopathy. It really helped me a lot. I really get scared when I remember those days. I smile now that I know I am out of it. Thanks a lot doctor!

End of the case.

 

 

 

 

About the author

Mahesh Gandhi

Dr. Mahesh Gandhi, M.D. (Psych) is a psychiatrist by profession and a homoeopath by choice. He has a flourishing practice and teaches internationally. He is globally popular for his psychiatric cases treated successfully with Homoeopathy. He has been closely associated with Dr. Rajan Sankaran for more than 15 years. Many of Dr. Gandhi’s cases have been published in Insight to Plants. He is now in the process of writing a book on homoeopathy about some of his experiences, especially in the field of psychiatry.

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